LAUSR

For some patients with both rectal and vaginal prolapse, a perineal approach to combined prolapse repair with rectal fixation would improve prolapse outcomes and be less morbid than an abdominal approach. Utilization of the sacrospinous ligaments and uterosacral ligaments for vaginal apical suspension has been well described with good surgical outcomes and improvement in vaginal prolapse symptoms. We describe using the sacrospinous ligament and uterosacral ligament as a point of fixation for rectal prolapse and vaginal prolapse via a transvaginal approach. Two patients with full thickness rectal prolapse and Stage 3 pelvic organ prolapse were evaluated for combined rectal prolapse and pelvic organ prolapse repair. Choice of surgical approach was based on comorbidities, frailty status, prior surgeries, possible hostile abdomen and need to avoid mesh procedures. One patient underwent transvaginal bilateral sacrospinous rectopexy with concurrent sacrospinous colpopexy and one patient underwent transvaginal bilateral uterosacral rectopexy with concurrent uterosacral colpopexy. At 1-year follow-up, both patients who underwent perineal approach with suture rectopexy and transvaginal apical suspension had no complications or symptomatic or anatomical recurrence. Transvaginal sacrospinous rectopexy and colpopexy and transvaginal uterosacral ligament rectopexy and colpopexy are both minimally invasive and technically feasible techniques for the treatment concomitant rectal prolapse and vaginal prolapse.